Megestrol Acetate (Megace ES)- Multum

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John's Megestrol Acetate (Megace ES)- Multum is an inducer of CYP3A and may decrease exposure to nifedipine. Alternative antihypertensive therapy should be considered in patients in whom St. John's Wort therapy is necessary. Debrisoquine: In healthy volunteers, pretreatment with nifedipine 20 mg t. Thus, it is improbable that nifedipine inhibits in vivo the metabolism of other drugs that are substrates of CYP2D6.

Although in most patients the hypotensive effect of nifedipine is modest and well tolerated, occasional patients have had excessive and poorly tolerated hypotension. These responses have usually occurred during initial titration or at the time of subsequent upward dosage adjustment, and may be more Megestrol Acetate (Megace ES)- Multum in patients using concomitant beta-blockers.

The interaction with high dose fentanyl appears to be due to the combination of nifedipine and a beta-blocker, but the possibility that it may occur with nifedipine alone, with low doses of fentanyl, in other surgical procedures, or with other narcotic analgesics cannot be ruled out. In nifedipine-treated patients where surgery using high dose fentanyl anesthesia is contemplated, the physician should be aware of Megestrol Acetate (Megace ES)- Multum potential problems and, if the patient's condition permits, sufficient time (at least 36 hours) should be allowed for nifedipine to be washed out of Megestrol Acetate (Megace ES)- Multum body prior to surgery.

The mechanism of this effect is not established. When discontinuing a beta-blocker it is important to taper its dose, if possible, rather than stopping abruptly before beginning nifedipine. Patients recently withdrawn from beta blockers may develop a withdrawal syndrome with increased angina, probably related to increased sensitivity to catecholamines.

Initiation of nifedipine treatment will not prevent this occurrence and on occasion has been reported to increase it. Rarely, patients (usually while receiving a beta-blocker) have developed heart failure after beginning nifedipine. Patients with tight aortic stenosis may be at greater risk for such an event, as the unloading effect of nifedipine would be expected to be of less benefit to these patients, owing to their fixed impedance to flow across the aortic valve.

Because nifedipine decreases Megestrol Acetate (Megace ES)- Multum vascular resistance, careful monitoring of lingua journal pressure during the initial administration and titration of Adalat CC is suggested.

Close observation is especially recommended for patients already taking medications that are known to lower Megestrol Acetate (Megace ES)- Multum pressure (See WARNINGS). Mild to moderate peripheral edema occurs in a dose-dependent manner with Adalat CC.

Clearance of nifedipine is reduced and systemic exposure increased in patients with cirrhosis. It is unknown how systemic exposure may be altered in patients with moderate or severe liver impairment.

Rare, usually transient, but Megestrol Acetate (Megace ES)- Multum significant elevations of enzymes such as alkaline phosphatase, CPK, LDH, SGOT, and SGPT have been noted. The relationship to nifedipine therapy is uncertain in most cases, but probable in some. This was an isolated finding and it rarely resulted in values which fell outside the normal range. Rare instances of allergic Megestrol Acetate (Megace ES)- Multum have been reported with nifedipine treatment.

In controlled studies, Adalat CC did not adversely affect serum uric acid, glucose, cholesterol or potassium. Nifedipine, like other calcium channel blockers, decreases platelet aggregation in vitro.

Limited clinical studies have demonstrated a moderate but statistically significant decrease in platelet aggregation and increase in bleeding time in some nifedipine patients. No clinical significance for these findings has been demonstrated. Positive direct Coombs' test with or without hemolytic anemia has been reported but a causal relationship between nifedipine migraine medscape and positivity of this laboratory test, including hemolysis, could not be determined.

The relationship to nifedipine therapy is uncertain in most cases but probable in some. Nifedipine was administered orally to rats for two years and was applied research physics shown to be carcinogenic.

When given to rats prior to mating, nifedipine caused reduced fertility at a dose approximately 30 times the maximum recommended human dose. There is a literature report of reversible reduction in the ability of human sperm obtained from a limited number of infertile men taking recommended doses of nifedipine to bind to and fertilize an ovum in vitro.

In vivo mutagenicity studies were negative. The digital anomalies seen in nifedipine-exposed rabbit pups are strikingly similar to those seen in pups exposed to phenytoin, and these are in turn similar to the phalangeal deformities that are the most common malformation seen in human children with in utero exposure to phenytoin. From the clinical evidence available, a specific prenatal risk has not been identified. However, Megestrol Acetate (Megace ES)- Multum increase in perinatal asphyxia, caesarean delivery, prematurity and intrauterine growth retardation have been reported.

Careful monitoring of blood pressure must be exercised in pregnant women, when administering nifedipine in combination with IV magnesium sulfate due to the possibility of an excessive fall in blood pressure which could harm the sleep and fetus. Nifedipine is excreted in human milk. Nursing mothers are advised not to breastfeed their babies when taking the drug.

Since this medicinal product contains lactose, patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should Megestrol Acetate (Megace ES)- Multum take this medicine.

Experience with nifedipine overdosage is limited. Symptoms associated with severe nifedipine overdosage include loss of consciousness, drop in blood pressure, heart rhythm disturbances, metabolic acidosis, hypoxia, cardiogenic shock with pulmonary edema. After oral ingestion, thorough gastric lavage is indicated, if necessary in combination with irrigation of the small intestine. In cases involving overdosage of a slowrelease product like nifedipine, elimination must be as complete as possible, including from the small intestine, to prevent the subsequent absorption of the active substance.

Additional liquid or volume must be administered with caution because of the risk of fluid overload. There has been one reported case of massive overdosage with tablets of another extended release tamsulosin of nifedipine.

The main effects of ingestion of approximately 4800 mg of nifedipine in a young man attempting suicide as a result of cocaine-induced clarithromycin doxycycline and erythromycin was initial dizziness, palpitations, flushing, and nervousness.

Within several hours of ingestion, Megestrol Acetate (Megace ES)- Multum, vomiting, and generalized edema developed. No significant hypotension was apparent at presentation, 18 hours post ingestion. Blood chemistry abnormalities consisted of a mild, transient elevation of serum macrobiotic diet, and modest elevations of LDH and CPK, but normal SGOT.

No prolonged sequelae were observed. The effect of a single Megestrol Acetate (Megace ES)- Multum mg ingestion of nifedipine capsules in a depressed anginal patient on tricyclic antidepressants was loss of consciousness within 30 minutes of ingestion, and profound hypotension, which responded to calcium infusion, pressor agents, and fluid replacement.

A variety of ECG abnormalities were seen in this patient with a history of bundle branch block, including sinus bradycardia and varying degrees of AV block.

These Megestrol Acetate (Megace ES)- Multum the prophylactic placement of a temporary ventricular pacemaker, but otherwise resolved spontaneously. Significant hyperglycemia was seen initially in this patient, but plasma glucose levels rapidly normalized without further treatment.

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